Depression, as a Responsibility

Okay, hear me out.

I’m going to go with heart first, and then head.

Heart:

Depression is real, and it is crippling. It is fueled by anxiety, and stress, and chronic pain, and trauma. It can come in waves, from mild to severe, and it can last a day or (seemingly) a few years. It shreds self-esteem, it takes away joy, it leaves you feeling numb and empty and without hope that things could ever or will ever change. When I conjure an image of depression, I picture the time when everything in my life appeared to be perfect: wife and home and kids and church and job, that time when I kept a giant smile plastered on my face, but on the inside I felt unworthy of love, isolated, torn to pieces. I felt like no one could or would see me, and I truly believed that happiness would forever elude me. I know what that dark, soul-crushing space feels like, and I know it can last for so long. Empty prayers, empty heart, empty rooms, empty me. I was merely existing. I once wrote suicide notes in that space. I know what depression feels like. It is real.

And now, Head:

Depression is a condition. A medical condition. It has a place in the medical books with a list of symptoms that follows it. It’s something that happens to people, most people if not all people, at some time in their lives. It’s a human condition, and thus part of being human. Some people struggle with it mightily and for their whole lives, while some only have depressed days or periods from time to time. Just like some people are born with a genetic predisposition to diabetes or asthma or heart disease or addiction, some might be born with a predisposition for depression. It’s a condition, and one that must be managed, with personal responsibility. And that requires an education, and understanding, and healthy life management around the condition.

Example: Diabetes has everything to do with blood sugars, and can be regulated with food intake and exercise. In some more extreme cases, it requires medication, or a doctor’s care, but these conditions too can be managed, even if it means facing some life alterations or restrictions.¬†Managing diabetes requires being educated about diabetes. It means learning what to eat, and how. It means knowing when to rest, and when to exercise. It means carrying insulin or fresh fruit or juice or candy to help manage the condition when it is out of control. It means educating others about the condition. It means… being responsible for it. For those who don’t manage it, who indulge and give little thought to consequences, they become burdened with the symptoms of the disorder, with low energy, frequent cravings, chronic pain, etc. For those who manage the disorder, despite the struggles that accompany its management, the burdens become easier to bear along with the healthier habits.

And in that same context, depression has everything to do with how the brain produces endorphins. It can be regulated with healthy relationships, nutrition and exercise, hydration, sleep, pain management, stress management, and coping mechanisms. And in some more extreme cases, it requires medication, or a doctor’s care, but these conditions too can be managed, even if it means facing some life alterations or restrictions. It must be managed.

There is a line from a Jason Mraz song that provided me with a lot of comfort when I was coming out of my own depression. The song is called Details in the Fabric, and it eloquently states in the chorus:

“If it’s a broken part, replace it.
If it’s a broken arm, then brace it.
If it’s a broken heart, then face it.”

If we as humans are responsible for ourselves (and we have to be!), then part of that means managing our own conditions. Whatever it is that is causing the depression has to be faced up to. Poor nutrition? An unhealthy relationship? An unfulfilling career? A disability? Chronic pain? The loss of a loved one? Too much stress? A lack of friends? Cold weather? An addiction? A broken heart? A low self-image? A traumatic childhood? Whatever it is, we have to take care of our own struggles and push through. We have to learn to get better. We have to be responsible for our own conditions.

In therapy, I frequently coach clients on how to get through the little tough moments. Little activities they can participate in to increase endorphin production in the brain. They don’t fix trauma or mend a broken heart, but they do help get through tough moments, hours, and days. And over sustained periods of time, we can break bad habits and start climbing out of the depression. The days get a bit easier a bit at a time. This is a ‘lose one pound per week for fifty weeks’ approach, as opposed to the ‘lose fifty pounds in one week’ approach that many hope for. Fixes aren’t often quick. New lifestyles take time to sustain.

Here’s the list. The brain naturally responds with serotonin and dopamine when we engage.

  1. Healthy eating. (Try being happy when you’re hungry or eating the wrong things).
  2. Water. (Try being happy when you’re thirsty or drinking only soda or coffee or energy drinks).
  3. Exercise. (Try being happy while consistently sedentary).
  4. Healthy human contact. (Friends! Therapy! Opening up and sharing with others!) (Try being happy when isolated, in stressful relationships, or while only engaging with others on social media).
  5. Sunlight. (Try being happy while remaining in dark rooms with the shades drawn).
  6. Achievement/getting things done. (Try being happy while constantly overwhelmed by what isn’t done, or while bored and lacking purpose.)
  7. Sleep. (Try being happy when sleeping too much or too little).
  8. Anti-depressants. (Medication isn’t always required, but vitamins and positive supplements are important. This also means avoiding stimulants and depressants, like too much alcohol and coffee, or other chemical-altering substances that exacerbate depression. Alcohol is the worst decision here).

We can not always control life circumstances, or even whether or not we have depression, but we can choose to participate with ourselves in our recovery from it. My depression, when I struggled with it, came from a combination from many things. My father had depression. I was sexually abused as a kid. I grew up gay in a world that told me gay people weren’t welcome. I grew up in a religion that had very high expectations, and left me feeling empty when I couldn’t measure up. I was physically abused by a step-father. I had scoliosis, and struggled with chronic pain. All of that, plus family stressors, before I was 18. I wasn’t responsible for any of those things. They were things that happened to me.

But somewhere along the way, given the stack of cards that I was dealt, I had to choose how to handle those things as an adult. I did a lot of things right: college, friends, therapy. But I did a lot of indulgent and difficult things as well, like too much food, further participation in the religion that was hurting me, and struggles with reconciling my own sexuality. I chose to get married and have children. I chose to keep eating, even when I became obese. I felt like there was no hope to make changes, and I participated in that hopelessness. And thus passed my 20s. A decade spent, responsible for myself and not handling it correctly. Wasted years. Good things came out of those years, like my college degree and my children, but they came from inauthentic spaces.

The process to healthy living for me required owning my past, my hurt spaces, my sexuality, my religious upbringing, my family culture, my food habits, my approach to relationships. It required exercise and healthy habits, therapy, journaling, financial responsibility. It required being a grown-up who loves themselves. It took work. And it got a bit easier, a bit at a time, over days, and weeks, and months, and years.

It required me loving myself, putting me first, along with my children, and healing from my past. It required me managing money appropriately, spending time with friends, learning how to process difficult feelings (like lonely and scared and angry and sad), keeping my home clean and tidy, exercising. It required me being responsible for me.

No one will just come along to save you. No prince will ride up on horseback, no surprise job will give you purpose, no lottery winning will take all your pain away. Because with the depression, even the magical things that happen feel like too much. The prince, the job, the lottery winnings, they feel just as hopeless as the rest.

And so back to heart: I know what it is like to live without hope. And I know what it is like to live happy. Life isn’t always easy. I have tough days. But it’s different. It’s so different. Struggles are manageable, temporary. I have tough hours or days, not a lifelong struggle of feeling broken. I got here. I did it. And now I’m working every day to stay here.

And I believe you can too. Be responsible for you, even when your insides tell you that you can’t. It’s so worth the effort. After all, what’s the alternative?

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Grandpa, at the end

My grandfather was a stubborn man. He’d always had a rebellious streak, and a quick laugh, and a sharp temper. I have distinct memories of him visiting us in Missouri, when we were young children. While Grandma made home-made donuts in the kitchen, he sat with us to play dominos or cards, cracking silly jokes that made us laugh, spouting nonsense.

“Well, I’m about to play my eight. You know what they say. Eight, skate, and donate!”

It was hard to watch him, there at the end. I had just received my mission call, and he had been a big part of my life the last several years, ever since Mom and Dad’s divorce. He’d been there for all of the key moments, along with Grandma. When we left Missouri, he gave us a place to live at first. When my step-father grew abusive and the later divorce got ugly, he and Grandma kept Sheri and I distracted and out of the courtroom. They were there at each of my Priesthood ordinations, when I starred in school plays, and when I graduated high school. In a few weeks, I’d be leaving for two years, to Philadelphia, Pennsylvania. But tonight, I sat at Grandpa’s side in the hospital.

“Chad. Chad-a-lad.” He called out softly, his voice thick with confusion. Just a few hours before, he hadn’t recognized me, I’d been a complete stranger to him. He was in and out of lucidity lately, the dementia setting in. Earlier today, he’d thought he was back on the farm as a child, and in the afternoon, he’d assumed he was in a bathtub on an airplane in the sky. It was heartbreaking to see him like this.

I got up out of the small twin bed they had wheeled in next to his hospital bed. “Hey, Grandpa, I’m right here.” I placed a hand on his arm, squeezing slightly.

“Chad, I have to use the bathroom,” he said. I took two steps toward the bathroom and turned on the light there. After my eyes adjusted, I found the small bottle they were using to collect his urine and returned to his bed.

“Of course, Grandpa,” I smiled.

“I hate that I can’t do this myself. I’m not some child.” His voice took on a tone of derision as I pulled his blankets and sheet down around the bottom of the bed. He had only one full leg now, the other having been amputated at the knee a few years before due to complications from diabetes. (His prosthetic foot and wheelchair both sat against the wall at the opposite side of the room).

“You’re definitely not a kid,” I reassured him, not knowing what else to say. I helped him fold his hospital gown up, so he could access his genitals, then helped him line the bottle up. He took it from my hands. “I can do this part myself,” he said with anger.

I turned my back, respectfully, as he prepared to pee. This was my fourth night in a row sleeping here in the hospital with him. I worked just downstairs, in the cafeteria, and it was easy for me to come and spend the evenings here. Grandma had asked me if I was sure I wanted to stay again, and I’d told her that I absolutely wanted to, it was the only thing I knew to do to help. She was home sleeping now and would be back first thing in the morning, along with another steady stream of company, some who Grandpa recognized and others who he didn’t, depending on how lucid he was throughout the day.

“Oh, shit! Oh, damn it all to hell, I can’t do anything right!” I swiftly turned back and saw that Grandpa had missed the bottle, sending urine spraying all over his hospital gown and sheets. Feeling heartbroken for him, I stepped into the hallway and flagged down the nurse, telling them what had happened inside.

Thirty minutes later, in fresh bedding, Grandpa went back to sleep, and I took a seat back on the bed, unsure if I’d be able to sleep again. I had a stack of comic books near the bed that I could read, but I didn’t know if it would help.

Grandpa had been such a proud man. Now he lay next to me, one leg gone, humiliated over being unable to pee by himself. He had tubes and wires connected to him, monitoring him. He was in his early 80s, and this wasn’t how he wanted to be, not at all.

In these later years, Grandpa’s life and been dominated by struggles with diabetes and heart disease, exacerbated by other health struggles. A few years before, he’d survived major heart surgery, yet on the drive home, Grandma had been in a horrible accident with Grandpa in the car, one that broke her neck (she recovered well) and put them both back in the hospital. But Grandpa had started declining after that.

Growing up Mormon in a small Idaho farming community, Grandpa had lost his father at a young age. He was the youngest of several siblings, and he’d grown up as the man of the house, supporting his mother however he could while balancing his life with just a bit of rebellion; he’d never served a mission, had had a habit of smoking, and he could be quite the prankster. Then he’d settled down with Grandma and, over the next five decades, raised four daughters and a son. He was a good dad, and a wonderful grandfather, despite that temper of his, one that lit quickly and burned out just as fast, and he was beloved by his family. He would be very missed once he was gone.

I dozed for a few hours, and the next morning, Grandpa didn’t recognize me again, wondering why there was a stranger in his room. I left, to shower and sleep a bit before I had to work hours later, and I couldn’t get him out of my mind. I thought of how he would put his small granddaughters on his feet and dance around with them while singing, how he took Sheri and I to the Dutch Treat Cafe for French fries and Iron Port Cherries, how he came over on Saturday mornings after our move to make us pancakes, how he’d pop his dentures out at his grandkids to scare them. What a life he’d led, and what a legacy he’d left behind, with five children, a few dozen grandchildren, and even more great-grandchildren. What a simple, happy, profound life he had lived.

Grandpa died just a few days later. He was surrounded by his wife and children. I wasn’t in the room. The last words he’d spoken to me were, “Hey there, Chad-Boy.” He’d spoken to me after not recognizing anyone else for hours, his eyes settling on mine, speaking with a smile as he pointed his finger right at me. He went peacefully, his breathing slowing, his eyes opening wide to something unseen, some vision of whatever lies beyond. He smiled, he closed his eyes, and then he let go, leaving his body behind in a room full of people who loved him.

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